The Management of Testicular Torsion in the Acute Pediatric Scrotum

Abstract

From July 1976 through June 1981, 51 children with acute scrotal pain and swelling underwent surgical exploration. Testicular torsion (27 cases) and torsion of an appendage (18 cases) were the most common diagnoses. In the group with testicular torsion 5 testes were considered unsalvageable and these were removed. The remaining 22 testes, including those of questionable viability, were left in place. The early salvage rate of 81 per cent decreased to 50 per cent due to testicular atrophy found in the late followup period. The attempt to salvage all testes except those with obvious necrosis resulted in minimal morbidity. This approach is discussed in view of recent reports of long-term damage to the contralateral testis when an ischemic testis is not removed initially.

Management of the acute scrotum in children

“…Kadish and Bolte did not find such symptoms helpful, 5 but noted that boys with testicular torsion tend to present after a shorter duration of symptoms 5 . This finding has been reported by other investigators 3,8–10 and is also seen in the present review, as is the observation that the average age of boys with testicular torsion is greater than that of boys with torsion of a testicular appendage (14.4 years, 7 14 years 5 and 11–17 years 6 compared to 9.4 years, 7 10 years 5 and 8–12 years 6 ). Despite such observations, the history and clinical features cannot be relied upon to differentiate testicular torsion from other diagnoses in the individual.…”

“…Torsion of a testicular appendage has been reported as the cause of the acute scrotum in 55%, 3 46%, 1 42%, 10 35% 6,12 and 24% 8 of boys. In the present review it is the commonest cause of acute scrotal symptoms and this correlates well with several studies, 1,3,10 although in other reviews, torsion of the testis is reported to be more frequent 7,8,12,14 …”

Torsion of the Testicle

“…The detorsion group had symptoms for 15 hours (range, 6Y168 hours), and the orchiectomy group had symptoms an average of 42 hours (range, 24Y96 hours). In 1983, Scott et al 49 reported on a series of 27 patients with TT. 49 In that series, most of the testes that were torsed for 12 hours or less were salvaged.…”

“…In 1983, Scott et al 49 reported on a series of 27 patients with TT. 49 In that series, most of the testes that were torsed for 12 hours or less were salvaged. The 5 testicles removed by orchiectomy were torsed for more than 24 hours.…”

Die einseitige intrauterine Hodentorsion, eine seltene Variante der Hodentorsion (Fallbericht und Literaturübersicht)

“…1984 berichtete Campbell in einem Fall in den USA (4), seitdem sind etwa hundert neonatale Torsionen in der Literatur analysiert worden. Die Hodentorsion kann in jedem Lebensalter auftreten, zeigt jedoch einen Häufigkeitsgipfel im Neugeborenenalter (10-12%) und in der Adoleszenz (1,6,11,19,21,23). Der Anteil pränataler Torsionen ist sehr gering, allerdings nicht exakt abzuschätzen, da bei einem nicht akuten Bild und nur später diagnostiziertem "vanishing testis" (Hodenatrophie) auch Infarkte durch vaskuläre Insulte ohne Torsion zugrunde liegen können (22 reichen Kapillarproliferaten und einer Fibroblastenproliferation (Abb.…”